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Surprise medical billing emerges as prominent issue at the Capitol

Surprise out-of-network medical billing is emerging as a prominent issue within the Georgia General Assembly. A surprise medical bill can occur when a consumer encounters an out-of-network (OON) provider at an in-network facility or in other circumstances. Three pieces of legislation have been introduced to address surprise billing and each attempts to resolve the issue in its own way. In this week’s legislative update, we will provide a broad look at each bill and its provisions. (If you would like more information about any of the bills, click on the provided links to read the full legislation.) All three bills seek to protect patients, and we will monitor and weigh in on the bills as they undergo the inevitable amendment process in committee. We appreciate all of the bill sponsors for remaining vigilant towards protecting patients from unexpected medical bills.

HB 678 is sponsored by Rep. Richard Smith, chairman of the House Insurance Committee, and has the backing of several powerful House lawmakers. The bill improves transparency for consumers by outlining the information that must be provided to consumers by health care providers and practices and by insurers. Providers must inform consumers about their participation in the patient’s insurance network and about how to check the network status of other providers with which the primary provider has coordinated services (e.g. laboratory or radiology services). It also requires insurers to provide consumers with information about when and how to receive approval for services from an out of network provider. Insurers must also communicate to a consumer ahead of a planned procedure if the provider is out of network (OON), and if so, the estimated amount the insurer will cover for the OON services. Lastly, HB 678 provides consumers with 90 days from the time of receiving a medical bill to pay the bill, negotiate payment or initiate arbitration through the Georgia Department of Insurance. After that time period, providers would be allowed to initiate collection proceedings to secure their payment.

HB 799: Out of network care in emergency situations

While HB 678 applies only to non-emergency situations, HB 799 applies solely to emergency care and medically necessary follow-up care. The legislation, sponsored by Rep. Sharon Cooper, Chairperson of the House Health & Human Services Committee, disallows managed care plans from denying payment for emergency services and disallows hospitals from billing patients for medically necessary care following an emergency situation except for their standard co-pays, co-insurance, and deductibles. For a patient receiving emergency care at an OON hospital and who is covered by a plan that requires prior authorization for post-stabilization care, the legislation outlines how the OON hospital and insurer must coordinate the patient’s transfer to an in-network facility and defines which entities are responsible for specific costs. Under this bill, if a patient (or their representative) does not consent to be transferred to an in-network hospital, the OON hospital must provide verbal notice to the patient that they may be financially responsible for any further post-stabilization care provided.

SB 359: Consumer Coverage & Out of Network Medical Care Act

SB 359 is the only Senate-side legislation introduced thus far to address surprise out-of-network billing and is sponsored by Senator Chuck Hufstetler, Chairman of the Senate Finance and member of HHS committees. The legislation contains many of the same transparency provisions for non-emergency care as HB 678 with regard to information that health care providers and hospitals must supply to consumers, but provides for more robust disclosure by insurers to consumers about possible OON costs. It also contains provisions similar to that of HB 799 with respect to emergency situations, but goes farther to stipulate that insurers must treat OON emergency care as if it were in-network by applying a consumer’s cost-sharing towards their in-network deductible and out-of-pocket maximum. The legislation also makes mediation available to consumers who receive elective medical care during which an unexpected event arises resulting in surprise bill greater than $1000. SB 359 is expected to be more controversial than the other two bills because it sets a payment resolution process that sank previous legislative attempts.

RSVP today for Cover Georgia Day at the Capitol!

Join us next Thursday, February 15th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of low-income Georgians. This is the most important step that our elected officials can take to slow the growing opioid crisis, strengthen our state’s struggling rural health care system, and improve the health & finances of hard-working, low-income Georgia families. Take advantage of this opportunity to talk with your elected officials about closing Georgia’s coverage gap! RSVP today!

Can’t make it?Send an email to your state legislators asking them to put an insurance card in the pockets of all low-income Georgians.

Legislation prioritized by Senate leaders approved by HHS Committee

At Thursday’s Senate Health & Human Services Committee, the two pieces of legislation resulting from the Health Care Reform Task Force were considered. Both SB 357 and SB 352 received strong support from legislators and stakeholders. GHF’s partners at the Georgia Council on Substance Abuse and Mental Health America of Georgia rose in support of SB 352, which would create a 15-member Commission on Substance Abuse & Recovery supported by a director. Both bills were passed by unanimous voice votes. You can find a description of both bills in last week’s legislative update blog.

New legislation would establish proposed Health Coordination and Innovation Council

Last week, the first legislation to result from the Lieutenant Governor’s Health Care Reform Task Force was introduced. SB 357, sponsored by Senator Dean Burke, would establish the Health Coordination and Innovation Council, the Health System Innovation Center, and an advisory board to the Council.

Health Coordination & Innovation Council

According to the Task Force’s final report, the Health Coordination and Innovation Council (aka “the Council”) will act as a permanent statewide coordinating platform, bringing together all of health care’s major stakeholders. As the legislation is currently written the Council will be made up of 13 members including the director of health policy & strategic planning, the Commissioners of the Departments of Community Health, Public Health, Human Services, and Behavioral Health and Developmental Disabilities, and eight members to be appointed by the Governor representing Georgia’s medical schools and academia and private health care sector. A consumer representative is not explicitly written into the bill text at this time.

Health System Innovation Center

The Health System Innovation Center is proposed as a research organization that utilizes academic, public health policy, data, and workforce resources to develop new approaches for financing and delivering health care in Georgia. The structure of the Center is not outlined in the legislation, but it is clear that its initial charge will be to synthesize existing studies and data to inform a strategic plan to improve access to health care in rural Georgia. The Center’s work will inform the Council.

We expect more legislation and proposals may emerge from the Health Care Reform Task Force in the coming days. As these proposals emerge, we will continue to keep you updated.

Legislation establishes Commission on Substance Abuse & Recovery

Senator Renee Unterman continues to spearhead efforts to address the opioid and substance use crisis in Georgia and last week, she introduced SB 352 which, among other things, establishes a Commission on Substance Abuse & Recovery. The Commission is to be headed by the director of Substance Abuse & Recovery and will serve as chair of the 15-member commission, including two representatives from the advocacy community. The Commission is charged with coordinating data among relevant government entities; informing strategies to combat the opioid crisis within the Departments of Public Health and Education, the Attorney General’s Office, and other state entities; consulting with the Governor’s office on a potential Medicaid waiver related to opioid abuse; and developing and informing other efforts to expand access to prevention, treatment, and recovery support services across the state.

Come to the state Capitol on February 15th!

Join us on Thursday, February 15th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of low-income Georgians. This is the most important step that our elected officials can take to slow the growing opioid crisis, strengthen our state’s struggling rural health care system, and improve the health & finances of hard-working, low-income Georgia families. Take advantage of this opportunity to talk with your elected officials about closing Georgia’s coverage gap! RSVP today!

Can’t make it?Send an email to your state legislators asking them to put an insurance card in the pockets of all low-income Georgians.

House continues to consider state budget bills

The Georgia House of Representatives continues its consideration of both the “little” and “big” budgets this week. HB 683, the FY2018 supplementary budget (also called the “little budget”), makes necessary, mid-year adjustments to the current state budget. The Governor’s proposed amended FY2018 budget provides an extra $5 million to the Georgia Trauma Care Network Commission from increased Super Speeder collections, but includes few other health care-related changes. The House Appropriations Committee and its subcommittees spent much of last week in budget hearings regarding the FY 2019 budget. The House’s consideration of the “big budget” will accelerate when they pass the FY2018 supplementary budget to the Senate for its consideration

The Legislature plans to finish work by March 29th

The schedule for the remainder of the legislative session has been set. Crossover Day, the day that legislation must move from one chamber to the other in order to be considered in 2018, will fall on February 28. The legislature will be in session Monday through Thursday each week until Crossover Day. The remaining 12 legislative days will be broken up throughout March, culminating on Sine Die, the last day of the session, on March 29th. The full calendar can be accessed here.